VIENNA (FRONTLINE MEDICAL NEWS) – Antipsychotic-naive children and adolescents are at greater risk for clinically significant weight gain during their first 6 months on a second-generation antipsychotic agent than adults, Covadonga M. Diaz-Caneja, MD, reported at the annual congress of the European College of Neuropsychopharmacology.

She presented what she believes to be the first prospective observational study comparing weight gain between antipsychotic-naive children and adults during their first 6 months on second-generation antipsychotics. Weight gains were significantly greater with olanzapine (Zyprexa) than risperidone (Risperdal) or quetiapine (Seroquel) in both age groups, but the magnitude and trajectory of olanzapine-related weight gain was significantly more impressive in the pediatric patients.

“What these results suggest is there are age-dependent differences in weight gain with the different second-generation antipsychotics. Careful evaluation of the risk-to-benefit balance should guide the choice of a second-generation antipsychotic for children and adolescents. And close monitoring of weight and metabolic disturbances in young people and adults treated with second-generation antipsychotics is warranted from the onset,” said Dr. Diaz-Caneja of Complutense University of Madrid.

The study included 226 pediatric patients with a mean age of 15.2 years and 135 adults, average age 39 years. All were antipsychotic naive when placed on one of the three second-generation antipsychotics at clinician discretion. Fifty percent of the youths and 60% of adults had a psychosis diagnosis. Sixty-four percent of the pediatric group and 55% of the adults were male.

Weight gain during the first 6 months of therapy was expressed as change in body mass index z score. An increase in BMI z score of 0.5 or more is considered clinically significant.

The increase in BMI z score in pediatric patients during their first 6 months on olanzapine was roughly twice as great as in adults on the drug. The bulk of the weight gain in children and adolescents occurred during the first 3 months of drug therapy, regardless of which agent they were taking. It happened more evenly over time in the adults.

The least weight gain at 6 months occurred with quetiapine in both age groups. However, the BMI z score increased by 0.532 in the pediatric patients on the drug, more than twice the 0.236 increase in adults.

Risperidone was the only second-generation antipsychotic where the weight gain trajectories in pediatric and adult patients were not significantly different.

The study was funded by the Spanish Ministry of Economy and Competitiveness, and the European Commission. Dr. Diaz-Caneja reported having no financial conflicts of interest.


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